Article
Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?
ANZ Journal of Surgery
(2015)
Abstract
Background: Pathological complete response following neoadjuvant
chemoradiotherapy (CRT) for locally advanced rectal cancer is associated with
reduced local recurrence and improved long-term outcome. However, the prognostic
value of a partial response, or of tumour regression in patients with metastatic disease,
is less clear.
Methods: We present a single-centre cohort study of 205 patients with stage II–IV
rectal cancer treated with surgery and neoadjuvant CRT between 2006 and 2013.
Tumour regression was assessed using the Dworak system.
Results: The probability of 3-year recurrence-free survival (RFS) was 95% for
Dworak grade 4, 82% for grade 3, 64% for grade 2 and 53% for grade 1 (P =
0.0005). In univariate regression analysis, Dworak grade was associated with RFS
(hazard ratio (HR) 0.51, P < 0.0001; trend analysis) and cancer-specific survival
(HR 0.52, P = 0.002). In multivariate analysis, Dworak grade remained an independent
predictor of RFS (HR 0.62, P = 0.012), along with clinical metastases stage,
resection margin status, the presence or absence of extramural venous invasion and
type of surgical procedure.
Conclusions: Tumour regression grade after neoadjuvant CRT was an independent
prognostic factor for RFS, highlighting the importance of the degree of local response
to CRT.
Disciplines
Publication Date
2015
DOI
10.1111/ans.13394
Citation Information
McCoy, M., Hemmings, C., Hillery, S., Penter, C., Bulsara, M., Zeps, N., and Platell, C. (2015). Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression? ANZ Journal of Surgery. DOI: 10.1111/ans.13394